Operational

Pre-admission clinic

Also known as: PAC, pre-anaesthetic clinic, pre-operative assessment clinic

A pre-admission clinic assesses patients before elective surgery to identify and optimise anaesthetic risk. Its persistent problem is allocation rather than capability — clinics are commonly booked out for weeks with low-risk patients while high-risk patients receive a phone call, because slots are filled in booking order rather than by screened risk.

Also called
PAC, pre-anaesthetic clinic
Purpose
Identify and optimise anaesthetic risk before elective surgery
Common bottleneck
Slots allocated by availability rather than by risk
Typical staffing
Clinical nurse consultants with anaesthetist review

The allocation problem

Most pre-admission clinics are not short of clinical capability. They are short of a mechanism for deciding who should be in them. Without one, appointments are allocated in the order bookings arrive, which produces a clinic full of healthy ASA 1 and 2 patients who need nothing, and a frail patient with poor functional capacity who gets a fifteen-minute phone call because the diary was full.

The consequence is felt in two places at once: theatre loses cases to problems that a clinic visit would have caught, and clinic time is consumed by patients for whom the visit changes nothing.

What changes with risk-based routing

If every booked patient is screened at the point of booking, the queue becomes orderable. Red-tier profiles go to anaesthetist review, moderate-tier profiles take the clinic slots, low-risk patients proceed without an appointment, and the remainder are handled by telephone. The clinic’s capacity does not change — its allocation does.

Related terms

Day-of-surgery cancellation

A day-of-surgery cancellation is a planned operation called off on the day it was scheduled, usually after the patient has arrived fasted. Most are preventable: the common causes are unmanaged medications, unoptimised comorbidity, unscreened risk such as sleep apnoea, and logistical failures — all of which are identifiable weeks earlier.

Prehabilitation

Prehabilitation is structured preparation before surgery — typically exercise, nutrition and psychological support, alongside smoking and alcohol reduction — aimed at improving a patient's physiological reserve before the stress of an operation. It treats the wait for surgery as an intervention window rather than dead time, which requires identifying who would benefit early enough to act.

Functional capacity (METs)

Functional capacity describes how much physical activity a patient can perform, measured in metabolic equivalents (METs). One MET is resting oxygen consumption. Four METs — climbing a flight of stairs or walking up a hill — is the usual threshold below which perioperative guidelines suggest further cardiac assessment before non-cardiac surgery.

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